Objective: To evaluate the effectiveness, toxicity and prospective application of hepatic arterial infusion (HAI) with embolized Curcuma Aromatic oil (CAO) in treating primary liver cancer (PLC). Methods: In the treated group, 32 patients with PLC were treated by HAI with 1-3 ml embolized CAO and oral administration of Chinese herbal medicine. In the control group, 32 patients with PLC were treated with transcatheter artery chemoembolization (TACE). Results: In the treated group, one patient attained complete remission (CR) and 13 partial remission (PR), the total effective rate being 43.75%. The level of alpha fetal protein (AFP) turned to normal range in 7 cases and decreased in other 7. In the control group, 10 obtained PR and the total effective rate being 31.25%, AFP level turned to normal in 5 and decreased in 2. There was no statistical significance between the two groups. The incidences of post-embolism Sydrome, such as fever, abdominal pain and vomiting were similar between the two groups but no myelosuppression occurred in the treated group with significant difference as comparing with that in the control group (P<0.01). The mean survival time, median survival time, 1-, 2- and 3-year survival rate in the treated group were 11.5 months, 10 months, 37.5%, 13.3% and 6.9% respectively, while in the control group they were 7.25 months, 6 months, 15.6%, 3.2% and 0% respectively. Better result in mean survival time, median survival time and 1-year survival rate was found in the treated group than that of the control group (P<0.05). Conclusion:HAI with embolized CAO showed a similar good effect in treating PLC as that of TACE, but superior to TACE with longer survival time and milder myelosuppression.

AIM To explore the method to prolong the survival of patients with postoperative rectal cancer and toprevent its recurrence.METHODS To analyze the reasons of recurrence after curative resections for rectal cancer of 399 patients.RESULTS Ninety out of 399 patients who received curative excision died of relapse of the tumor. Pelvicrecurrence was found in most of the patients followed by liver and pulmonany metastasis. The survival timein Dukes A was the longest and in Dukes C the shortest. The survival period was 12 months longer, in thepatients receiving pre-operative radiotherapy than that did not. Inadequate excision of the primary tumor orthe draining lymph nodes was the main cause for local recurrence.CONCLUSION Adequate surgery and adjuvant therapy are the most effective methods to prolong thesurvival of patients with postoperative rectal cancer and to prevent its recurrence.

AIM To clarify the surgical strategy for patients with stage Ⅳa primary hepatic carcinoma (PHC).METHODS Twenty-seven patients with stage Ⅳ a PHC were retrospectively studied in 1989 - 1998,including resected group (19 cases) whose all tumor nodes were resected and cytoreductive group (8 cases)whose most tumor nodules were resected and remnant nodules treated by ethanol injection. B-ultrosoundshould be used intraoperation in order to prevent from missing any tumor nodule. All the tumor nodules inthe liver should be removed, and residual nodules should be treated by ethanol injection during operation ifall the tumor nodules can not be removed. Multidisciphinary therapies were undertaken perioperatively.RESULTS The 1-, 2- and 3-year survival rates were 71.4%, 55.6% and 7.7% respectively. The 1-, 2- and3-year survival rates of the resected and cytoreductive groups were 73.3%, 53.3%, 10.0% and 66.7%,50.0%, 0% (P>0.05) respectively. The rate of complications was 22.0%, without operative and in-hospital mortality.CONCLUSION The surgical treatment included resected or cytoreductive operation plus supplementarytherapy considered to be both useful and the first choise for stage Ⅳa PHC.

INTRODUCTIONAlthough the long-term postoperative survival rate of gastric cancer (GC) patients has been improved significantly since the local dissection of lymph node was widely used in China, yet the low curative resection rate and the high recurrence rate from peritoneal and hepatic metastases hinder it from further improvement. To alter the current unsatisfactory status of GC treatment, a sequential triple therapeutic scheme (STTS), consisting of preoperative regional intra-arterial chemotherapy,curative resection of GC, and intra-operative or early postoperative intraperitoneal chemotherapy, was designed and adopted in this department since 1989. The follow-up data demonstrated that the therapeutic response of STTS is rather satisfactory.The results are reported as follows.

AIM To establish a new improved vascular anastomotic technique to simplify the surgical technique and increase the survivsl rate of small intestinal transplantation in rats.METHODS The graft removed en bloc consisted of entire small intestine, portal vein and aortic segment with superior mesenteric artery. The graft was perfused in situ and the gut lumen was irrigated during the operation.Heterotopic small bowel transplantation was performed by microvascular end-to-side anastomosis between the donor aortic segment with superior mesenteric artery and the recipient abdominal aorta, and by the formation of a "Cuff" anastomosis between the donor portal vein and the recipient left renal vein. Both ends of the grafts were exteriorized as stomas. RESULTS A total of 189 intestinal transplantations were performed in rats, 33 of which were involved in the formal experimental group, with a survival rate of 84.8%. The average time for the donor surgery was 80min ±10min; for graft repair 10min ± 3min; and for recipient surgery 95min ± 15min. The average time for the arterial anastomosis and the vein anastomosis was 18min ± 5min and imin,respectively. The warm ischemic time and cold ischemic time were 22min ± 5min and less than 60min, respectively. The whole operation was completed by a single surgeon, the operative time being about 3 hours. CONCLUSION The vascular anastomosis used in this study could simplify surgical technique,reduce the operative time and elevate the survival rate of small intestinal transplantation in rats.

积极开展胰头癌根治术--为提高五年生存率而努力

一、重视外科治疗手术切除是唯一可能治愈胰头癌的有效方法.但是,长期以来外科治疗的效果不佳,使得大家有一种无奈的情绪,认为依靠手术的方法是难以提高治疗效果的,因而把希望寄托于早期诊断.如能早期发现、及时诊断,当然治疗的效果要好得多.近年来诊断技术有较快的发展,如内腔镜超声、内腔镜穿刺活检、核磁共振、Ki-ras基因检查,胰液及粪便的基因检查等等.然而,问题在于早期胰腺癌没有任何症状,或只有很轻微的消化道症状,患者根本不来就医,根本无法去发现.以后出现了一些非特异性的症状,也是先去内科或其他科求治.所以极大部分病人来外科就医时病情已属Ⅱ、Ⅲ期,甚至Ⅳ期.面对这一现实的问题,外科医师,尤其是专业的胰腺外科工作者,只有努力去研究和提高对Ⅱ,Ⅲ期胰头癌的治疗水平,重视手术技术,不仅满足于能进行一般的Whipple手术切除了肿瘤,而是要求达到合理地做好根治术.事实上这样做的结果确实不同程度地提高了疗效,这需付出艰苦的努力,并开展术前术后的综合治疗才能使手术的疗效得以提高.

加强早产儿合并症的防治 提高存活率及生存质量

早产带来的高围产儿死亡及体格、智能发育障碍是儿童医疗保健的难题[1,2].早产导致的高额花费与其预后对比,是多年来医学伦理学争论的重点.为救治危重早产儿特有的多系统、多器官的合并症,新生儿学界在基础、临床和康复等领域做了大量工作,使预后明显改善.近在青岛召开的以"早产儿"为主要议题的第六届全国暨第三届海峡两岸新生儿学术会议对进一步提高早产儿存活率及生存质量起到了促进作用.

Department of radiation Oncology,University of Maryland School of Medicine USA The war against cancer is a war not yet won. Over the years we have made significant progress in cancer treatments. However,viewing from the end point-the survival rate,the results remain very disappointing. Of the all patients diagnosed with cancer in the world,approximately 45% will eventually die as a result of recurrence and/or metastasis. Radiation therapy is one of the major modalities for cancer treatment,it had contributed significantly in saving the lives of patients inflicted with cancer and improving their quality of life. However,it also has its share in the disappointiong statistics with all other modalities. Over the last 5 decades,radiation therapy has gone through many advances both in equipment and in treatment methods. The impact,however,falls short as compared with the expectations. It is possible that the efficacy of radiation therapy has reached its limits. It is also possible that what we have done in the past has some major shortcomings in its methodology,which may require revolutionary improvement. Conformal radiation therapy as a new treatment technique provides us some hope in answering these key questions.

Objective: To investigate the relationship between the prognosis of Epithelial Ovarian Cancer (EOC) and its ascites. Methods: Retrospectively analysis is performed for the clinical, pathological and followed up data of 101 in-patients suffering from epithelial ovarian cancer and operated with tumor debulking surgery in our hospital from January 1986 to December 1993. The patients was divided into two groups based upon the first laparotomy finding with ascites(62) or without(39). Age average, cell type, advanced proportion and survival rate of the patients are evaluated by a c2 test. Results: For age average and cell type, no statistical difference was noted. However, there were more advanced cases in ascites group than in the other (P<0.01). The 3-, 4- and 5-year survival in the no-ascites group were 87.02%, 73.42%, 57.10% respectively compared with 65.02%, 38.66%, 28.12% in the ascites group. The 5-year survival rate of stage I, II,III, IV patients in no-ascites group are 77%, 70%, 41.1%, 0 respectively, compared with that of 60%, 56.8%, 15.46%, 0 respectively in the ascites group. The results shows that 3-, 4-, and 5-year survival in no-ascites group were significantly higher than those in ascites group(P<0.01). Conclusion: Presence of ascites is a factor of poor prognosis for EOC.

The thyroid hormones, triiodothyronine and thyroxine, play important roles in cognitive func-tion during the mammalian lifespan. However, thyroid hormones have not yet been used as a therapeutic agent for normal age-related cognitive deficits. In this study, CD-1 mice (aged 24 months) were intraperitoneally injected with levothyroxine (L-T4;1.6μg/kg per day) for 3 consecutive months. Our findings revealed a significant improvement in hippocampal cyto-skeletal rearrangement of actin and an increase in serum hormone levels of L-T4-treated aged mice. Furthermore, the survival rate of these mice was dramatically increased from 60%to 93.3%. The Morris water maze task indicated that L-T4 restored impaired spatial memory in aged mice. Furthermore, level of choline acetyltransferase, acetylcholine, and superoxide dismutase were in-creased in these mice, thus suggesting that a possible mechanism by which L-T4 reversed cognitive impairment was caused by increased activity of these markers. Overall, supplement of low-dosage L-T4 may be a potential therapeutic strategy for normal age-related cognitive deifcits.

早期康复治疗对脑卒中偏瘫患者预后的影响

INTRODUCTIONCerebral apoplexy has high morblity, mortality, disablement rate. InChina the resident's cause of death was of cis-position in 2000 year. Incities cerebrovascular patients were 127.9%thousands, in countries115.20% thousands. All the cause of death was at the second posi-tion. One month survival rate of cerebral apoplexy was about 70% -90% ,one year survival rate was about 50% - 80%. Most survivors haddysfunction to varying degrees and they needed recovery treat-ment. Early rehabilitation' s purpose is to protect from complications,disuse syndrome and to develop normal motor reaction and motor form.

整体护理中健康教育对喉癌患者的康复作用

BACKGROUND: Resection is now considered as the principlemethod for curing laryngocarcinoma. However, kinds of ways of re-section do harm to phonation, respiration and protective function al-though better survival rate can be achieved. So it is important forpatients with laryngocarcinoma how to improve life quality and givehealthy education of patients in different phase.

综合康复治疗断指再植术后肌粘连87例

Background: Replantation of served fingers had been adopted widely and its survival rate was also increased greatly. But incidence of dysfunction due to muscle tendon adhesion was still very high.

Objective To explore the factors influencing the prognosis of patients with primary liver cancer(PLC) after hepatectomy on purpose to provide the preventive measures for improving the long-term effect.Methods All of the 189 patients who underwent hepatectomy with PLC from May,1994 to January,1998 were included by reviewing their clinical pathological characteristics and treatments. Totally, 22 factors contributed to the long-term survival rate(SR)and the disease-free SR were analysed . All patients were followed up at least 5 years. Results The 3- and 5-year cumulative SRs in the total group were 63% and 45% respectively. The 3- and 5-year SRs and disease-free SRs in the curative resection (CR) group (n=162) were 67%,47%,and 45% and 26% respectively. It was showed that the way by which a tumor was found, tumor size, portal thrombi, satellite nodule, cirrhosis type, TNM stage, tumor envelope, recurrence and treatment, vascular exclusion and transfusion, differentiation grade and CR were prognostic factors by individual variable analysis. A multivariable analysis showed that CR , tumor size and reoperation were significant factors associated with the prognosis. Conclusion The type of CR and tumor size are determinants influencing the prognosis. Early diagnosis of small carcinoma and CR as soon as possible is essential to improving the prognosis of PLC. Avoiding transfusion and controlling the progress of cirrhosis are expected to improve the disease-free SR.

加强肝移植围手术期处理,提高生存率

近年肝脏移植在国内大、中医院广泛开展,但由于我国开展肝移植时间较短,各单位施行例数差别大,临床肝移植经验尚待积累.尽管如此,在我国一些大的中心围手术期生存率已接近或达到国际水平.

骨盆骨折失血性休克治疗进展

骨盆骨折大出血多因高能量创伤所致，常造成患者血液动力学不稳定。迅速有效地控制骨盆骨折患者大出血仍是临床治疗难点，尚缺乏公认的临床诊疗规范。外固定和血管造影栓塞等治疗方法不断发展，可有效提高骨盆骨折大出血患者生存率，但仍有局限性。本文就骨盆骨折大出血治疗进展作一综述。

小儿肝母细胞瘤

本文对1975～1985年间收治的35例肝母细胞瘤进行临床分析.1981～1985年经改进治疗方案,放宽手术指征,改进手术操作,坚持化疗和免疫治疗,二年成活率由66.6%升到87.5%.

小儿特大面积烧伤的休克与补液治疗

小儿大面积烧伤,特别是总面积在50%以上者,其休克和死亡率均显著增加.今报告15年来收治的12岁以下、烧伤总面积在50%以上的病例,并就其休克期的补液治疗等有关问题进行讨论.